Bone‐marrow examination in the staging of small‐cell anaplastic carcinoma of the lung with special reference to subtyping: An evaluation of 203 consecutive patients

Histologic examination of bone‐marrow from the posterior iliac crest was routinely done as a pretreatment staging procedure in 203 consecutive patients with small‐cell anaplastic carcinoma of the lung. Subtyping of the patients according to the WHO classification included 27.8% with “fusiform” cell type (WHO II,1), 28.3% with “polygonal” cell type (WHO II,2), 42.8% with “lymphocyte‐like” cell type (WHO II,3), and 1.1% with mixed types (WHO II,4). Bone‐marrow involvement was found in 17.2%. No significant difference was observed among the histological subtypes with regard to bone‐marrow involvement. A comparison of bone‐marrow biopsy and aspiration in patients investigated with both procedures showed that aspiration alone was diagnostic in nine of 24 (38%) positive patients as compared with two of 24 (8%) with biopsy alone, while in the remaining 13 patients (54%) both procedures were positive. Of the 35 patients with positive bone‐marrow examination, 77% had no other evidence of distant metastatic disease if liver metastases identified by peritoneoscopy and liver biopsy are excluded as a staging procedure. With the exception of thrombocytopenia which was observed in six patients, with bone‐marrow metastases, hematological findings were of little value in detecting bone‐marrow involvement.